第16届亚运会医疗设备入境申报表.docVIP

第16届亚运会医疗设备入境申报表 The 16th Asian Games IMPORTATION OF MEDICAL EQUIPMENT 代表团名称NOC: 代表团编号NOC Code: 团长姓名Chef de Mission: 队医姓名NOC Team Physician: 邮政地址Mailing Address: 电话Phone Number: 传真Fax Number: 电邮E-mail: 请用中、英文填写（如需更多填写空间，请自行复印本表） Please type or print the requested data in Chinese or English (Photocopy blank form if more space is required) 设备名称（型号） Equipment name (Model) 数量 Quantity 生产地 Production place 主要用途 Main use 放射源（附属或产生） Radioactive source 备注 Remark 本人声明，以上所列设备非管制设备，专为第16届亚运会亚运会本代表团使用。亚运会结束后将全部带出中国。 I hereby declare that the equipment listed above is not regulated, and is imported into China for the use of my organization only during the 16th Asian Games. They will be re-exported out of China after the Games. 医务官签署 NOC Chief Medical Officer 日期Date 代表团签署及盖章 NOC Signature and Stamp 日期Date 注意：本表格需于2010年 Special Notice: This form must reach GAGOC no later than April 1, 2010. 地址：中国广州市天河区天河路299号（510620） Address: Medical Services Department, Guangzhou Asian Games Sports and Culture Centre, 299 Tianhe Road, Tianhe District, Guangzhou (510620), P.R. China 联系人：陈宇斐 余革 Contact Person: Chen Yufei，Yu Ge 电话Tel：86-20传真Fax：86-20电邮E-mail：ylwsb@ 网址Website: